Surgical Management of Brainstem Cavernous Malformation: Report of 67 Patients.

Abstract:

BACKGROUND:Brainstem cavernous malformations (CMs) are benign lesions, often show an acute onset, and result in a high rate of morbidity. Surgical resection could inhibit the progressive deterioration of neurologic function caused by repetitive hemorrhage. This study aimed to summarize timing, approaches, and techniques of surgery and to evaluate outcomes of treatment. METHODS:Between March 2011 and May 2013, 67 patients (32 male, 35 female; average age 40 years; range, 14-68 years) with brainstem CMs received surgical treatment. Clinical presentation, surgical approaches, and results of follow-up were retrospectively analyzed. RESULTS:Seven surgical approaches were used: orbitozygomatic approach (1 case), suboccipital transtentorial approach (Poppen approach; 3 cases), subtemporal transtentorial approach (32 cases), subtemporal transtentorial/anterior petrosectomy approach (9 cases), suboccipital retrosigmoid approach (3 cases), midline suboccipital approach (16 cases), and far lateral approach (3 cases). Total resection of the brainstem CM was achieved in all cases (100%). No operative mortality was encountered. Nine patients had new symptoms after surgery: 3 had diplopia, 3 had facial numbness, 1 had numbness of contralateral limbs, 1 had transient aphasia, and 1 had reduced muscle strength of contralateral limbs. Symptoms significantly improved in 23 patients (34.3%), symptoms were unchanged in 36 patients (53.7%), and new postoperative symptoms occurred in 9 patients (13.4%). CONCLUSIONS:Choosing a proper surgical approach and using appropriate techniques are fundamental for favorable outcomes of patients with brainstem CMs.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Gui S,Meng G,Xiao X,Wu Z,Zhang J

doi

10.1016/j.wneu.2018.11.008

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

e1162-e1171

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(18)32555-5

journal_volume

122

pub_type

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